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Studying organ sales: short term profits, long term suffering
By Jeffrey P. Kahn, Ph.D., M.P.H. (Director, Center for Bioethics, University of Minnesota)
An article in this week's issue of the Journal of the American Medical Association looks at the effects of kidney sales done in a large city in southern India, where, according to the article, the practice has been going on for more than a decade. The 350 people interviewed for the study reported the average amount they received for a kidney was just over $1,000. The vast majority reported selling a kidney to pay off debts, but nearly 75 percent said they were still in debt six years later. Moreover, the number of individuals living in poverty actually increased from 54 to 71 percent after the kidney sale, with average family income falling by a third. More than 85 percent reported that their health declined after the donation, and almost 80 percent said they would not recommend selling a kidney. What do these results mean for organ sales and what lessons can we take from them? Markets and exploitationThe findings reinforce a concern that many have expressed -- that the sale of organs could lead to exploitation. They worry that markets in organs are potentially unfair to both donors and recipients. If money is offered to organ donors, the most desperate will be the most easily attracted. In other words, if everybody has a price, the price will be lower for those who need money the most. As the study shows, desperate people may do desperate things. They may be tempted to overlook the risks -- both physical and social -- of giving a kidney, and may be nearly blind to anything but the prospect of payment. Markets for organs can also be unfair to organ recipients, especially if the markets take the form of auctions, where the highest bidder would get organs first. Such a scenario takes the worst aspects of markets and applies them to organ donation -- desperate people are exploited for their kidneys, and the wealthy get to jump to the front of the queue for scarce medical care. The rich could avoid the risks of donating kidneys to their loved ones themselves, and effectively pay others to bear the risks for them. Why worry about India?A story about kidney sales in India may sound distant in many other parts of the world, but proposals to test limited markets for kidneys in the U.S. mean that these lessons deserve a hard look. The kidney donors interviewed in India have much more in common with the rest of the world than one might expect. Economic hardship is known the world over, from underdeveloped countries to the most advanced countries of Europe and North America. We can all think of parts of our own country where people would be tempted to sell their future for as little as $1,000. The Indian study doesn't put to rest the debate about the sale of organs. But it does call into question the arguments that allowing people to sell their kidneys will offer them economic futures that are otherwise out of reach. Instead, it seems to offer a future even bleaker than what they are trying to escape. Increasing the supply of organs for transplant is a laudable goal, but as the study shows, the human costs far exceed the price the organ will fetch. Such exploitation makes sweatshop labor look tame by comparison -- how to compare underpaying people for stitching soccer balls with underpaying them for their kidneys? Both prospects dehumanize human beings, and should remind us that dehumanizing any one of us dehumanizes us all. Visit the
"Ethics Matters" Archive where you'll find other columns from Jeffrey Kahn on a wide range of bioethics topics.
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